PhilHealth Annex A.1: Checklist of Eligibility Criteria for Diagnostic Tests and Prognostication –
Fill PhilHealth Annex A.1: Checklist of Eligibility Criteria for Diagnostic Tests and Prognostication – online and download the official form as a PDF, ready to print. Every input is mapped to its printed box, so IDs, dates and amounts land digit by digit in the right cells, and a value the form cannot hold is refused with the reason instead of being printed wrong.
What you will need: Case No, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, 1. Positive (+) breast mass; AND/OR, 2. Palpable axillary lymph node, 4. Biopsy results (malignant breast cancer), 5. Immunohistochemistry (IHC) result 2+, 6. HER2 status results is not clear or equivocal, Certified Correct by, PhilHealth Accreditation No, Date signed (mm/dd/yyyy), Conforme by.
Free to try: 5 forms a day without an account; a free account gets 14 days of clean PDFs, then 25 a month. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.